title: One-stoma carinoplasty: right upper sleeve lobectomy with hemicarinectomy for resection of right-tracheobronchial-angle tumors.
abstract: Tracheobronchial-angle tumors involve the right main bronchus, the right upper lobar bronchus, and the lateral wall of the lower trachea. Resecting these tumors is one of the most complex procedures in thoracic surgery. In cases of high-caliber mismatch, the selection of a suitable anastomotic technique can be challenging. We found that our use of a one-stoma carinoplasty technique overcame high-caliber mismatch after the resection of these tumors. From 2009 through 2012, 8 men (mean age, 59 ± 6.2 yr; range, 46-66 yr) underwent complete resection of non-small-cell right-tracheobronchial-angle tumors at our institution. In every case, right upper sleeve lobectomy, wedge carinal resection, and one-stoma carinoplasty were applied. After tumor resection, one patient with hemoptysis and bronchopleural fistula underwent a completion pneumonectomy and died 10 days postoperatively. Bronchoscopy was necessary in 2 patients who had atelectasis in the contralateral lung. At a mean follow-up duration of 19.43 ± 8.4 months (range, 0.2-27.1 mo), 6 patients were alive and free of disease. We conclude that our one-stoma carinoplasty technique enables the resection of tumors at the right tracheobronchial angle, with acceptable morbidity and mortality rates. This method saves the unaffected part of the ipsilateral lung and can overcome high-caliber mismatch. Because of these and other advantages, we suggest that using our method first might preclude having to perform a right carinal sleeve pneumonectomy or using Barclay's method.
authors.affiliation: General Thoracic Surgery Clinic, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Investigation Hospital, 35360 Izmir, Turkey.
authors.forename: Seyda Ors
authors.initials: SO
authors.lastname: Kaya
authors.forename: Serpil
authors.initials: S
authors.lastname: Sevinc
authors.forename: Kenan Can
authors.initials: KC
authors.lastname: Ceylan
authors.forename: Ozan
authors.initials: O
authors.lastname: Usluer
authors.forename: Saban
authors.initials: S
authors.lastname: Unsal
mesh_terms: D000368:Aged; D001980:Bronchi / Q000473:pathology / Q000601:surgery*; D001999:Bronchoscopy; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006469:Hemoptysis / Q000209:etiology / Q000601:surgery; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D001261:Pulmonary Atelectasis / Q000209:etiology / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000401:mortality; D012086:Reoperation; D016156:Respiratory Tract Fistula / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D054047:Surgical Stomas / Q000009:adverse effects; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014132:Trachea / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Bronchi/pathology/surgery; bronchial neoplasms/surgery; carcinoma, squamous cell/surgery; reconstructive surgical procedures/methods; trachea/surgery; treatment outcome